The value of peer mentoring for the psychosocial wellbeing of junior doctors: a randomised controlled study

To the Editor: I commend the Medical Journal of Australia for supporting high quality qualitative research with clear criteria for acceptance for publication1 on the background of increasing concerns these manuscripts are being rejected for reasons not based on the quality of the article submitted.2

However, I am concerned about the article by Chanchlani and colleagues,3 which involves randomised controlled evaluation of a peer mentoring program for new medical interns using qualitative interview‐based methodology.3 The Journal's Editor‐in‐Chief hoped this methodology would “encourage others to use comparable approaches when investigating similar topics”.4

A well conducted randomised controlled trial is considered among the highest level of evidence base for clinical practice; randomisation minimises bias from known and unknown confounders. However, other biases (selection, recall, measurement etc) also need to be controlled for randomised controlled trials to provide valid results and conclusions.

Chanchlani and colleagues3 suggested their primary outcome was to assess psychosocial wellbeing and job satisfaction using inductive thematic analysis of data collected in semi‐structured interviews and focus groups at 12 months. This is different from the Australian New Zealand Clinical Trials Registry (ACTRN12618000455268, retrospectively registered) description which is “to determine the perception of the effectiveness of peer support on anxiety and depression;” the psychiatric training of the interviewers and the formal screening or post hoc assessment of the participants’ mental health are unknown.

Qualitative research in randomised controlled trials is increasingly common, with new innovative purposes.5 Chanchlani et al3 reported a novel approach to qualitative research incorporating randomised controlled methodology; no quantitative data are apparent in outcome analysis, even though such measurement can be obtained from a post‐program feedback survey for both groups. Interview questions published in the online appendix cannot properly compare satisfaction rate nor assess the state of mental health. More is needed to justify comparative comments such as “participants with mentors reported high satisfaction with the program and a positive impact on stress levels, morale, sense of support, job satisfaction, and psychosocial wellbeing compared with participants without mentors”.

It is desirable that the MJA supports innovative qualitative research. Important information may be omitted due to editorial requirements. Nevertheless, vigorous peer review and academic integrity are still needed. Care should be taken when comparative conclusions are made without adequate explanation.